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Auto-generated email messages from EHRs can contribute to physician burnout

The time physicians spend on desktop medicine appears to be increasing compared to the amount of time they can spend with patients. The cause of this switch is likely the obvious current enemy of healthcare: electronic health record (EHR) documentation.

In particular, it’s the emails generated by EHRs that are the problem.

According to a new study, physicians' EHR inboxes are stuffed with system-generated messages on behalf of the electronic health records they are operating within their organizations, which can lead to job dissatisfaction and even burnout, Health Affairs reported.

Per the study’s findings, about half of the total weekly messages in physician inboxes came from EHR auto-generation related to population health management algorithms that remind physicians to order tests, for example. Because of the copious messages load generated by the EHR, physicians tend to find themselves buried, which leads to the burnout and leads to fewer hours spent on clinical care, the study authors prescribe.

Burnout has been a topic of growing concern throughout healthcare. The causes of burnout are various, including workload; efficiency; meaning in work; culture and values; control and flexibility; social support and community at work; and even work-life integration — or “balance” as it is often called.

The study’s authors pointed to a growing amount of research that suggests that time spent by physicians on the EHR has been linked to their reduced satisfaction with work. “An analysis of EHR log data on the distribution of work time of 471 primary care physicians (in family medicine, internal medicine, or pediatrics) suggests that more than 50 percent of their time is spent on desktop medicine tasks,” they said.

A study of 142 family physicians reports that managing the EHR’s inboxes takes an amazing amount of time greater than 23% of their workday.

“Given the correlation between physician workload and desktop medicine and the rising number of physicians who report burnout, it is important to carefully examine the relationship between pivotal aspects of desktop medicine and physicians’ well-being,” the researchers said.

In the Health Affairs study, survey data from 900 physicians and administrative staff and EHR data from the Palo Alto Medical Foundation were used to study the association between "desktop medicine" and physician well-being. Specialties were grouped into six categories: family medicine; internal medicine; pediatrics; surgical; nonsurgical procedural and non-procedural specialties focused on evaluation; and management-oriented services.

The average number of weekly inbox messages was 243, of which 114 (47%) were generated by the EHR system, including pending orders automatically sent to physicians according to algorithm-driven health maintenance reminders, requests for prior authorization, patient reminders and many more.

Only 30 messages per week were directly from patients. Fifty-three were from other physicians or care team members and 31 were from the physicians themselves, for example, reports of laboratory tests they had ordered. 42% of physicians received above the average number of messages. System-generated messages stood out as the largest source of messages for all specialties, especially for internal medicine and family medicine, followed by pediatricians.

Results suggested that receiving an above-average number of system-generated messages was associated with a 40% increase in the probability of burnout and a 38% increase in the probability of intending to reduce clinical work hours, the study authors said.

"Using computer algorithms to send messages to physicians may need to be balanced with considerations of what brings joy and which tasks are truly physicians’ work," the study authors wrote. "When we discussed the absence of a significant relationship between burnout and progress notes work with physicians, we learned that they considered work in progress notes to be work that they perform with more autonomy. They derived professional satisfaction from writing good notes.”

The study authors also note that family physicians and internists receive disproportionately high numbers of system-generated messages, more than 2.5 times the volume of surgeons, four times that of non-procedural evaluation and management-oriented specialists, and five times that of nonsurgical proceduralists.

"Healthcare organizations need to reconsider some of their approaches to improving the quality of care and population health. Physicians might not be the most appropriate recipients of some system-generated messages," the study authors said.

To reduce the number of messages reaching physicians’ inboxes, some messages, such as prescription refill requests, may be delegated to non-physician clinicians, registered nurses or clinical pharmacists on the care team.

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About the Author

Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.